Maternity Flashcards
(108 cards)
1
Q
Preg hematocrit
A
32-42%
2
Q
Hemoglobin
A
10-14 g/dL
3
Q
Platelets
A
150,000-350,000 significant increase 3-5 days after birth ( predisposes to thrombosis )
4
Q
Partial thromboplastin (PTT)
A
12-14 seconds Slight decrease in pregnancy and again in labor (placental site clotting )
5
Q
Fibrinogen
A
400 mg/dL
6
Q
Fasting serum glucose
A
65 mg/dL
7
Q
2 hour postprandial serum glucose
A
Less than 140mg/dL
8
Q
Total protein
A
5.5-7.5 g/dL
9
Q
White blood cell
A
5000-15,0000/mm
10
Q
Polymorphonuclear cells
A
60-85%
11
Q
Human chorionic gonadotropin hormone (hCG)
A
Is present in maternal blood serum 8-10 days after fertilization just as soon as implantation has occurred. After 5-70 days hCG begins to decrease as placental hormone production increases. Similar to luteinizing hormone (LH) and prevents the involution of corpus luteum at the end of the menstrual cycle. The response of hCG is to increase secretion of estrogen and progesterone.
12
Q
Progesterone
A
Is an essential hormone of pregnancy. It must be present in high levels for implantation to occur. At 16 days after ovulation, progesterone reaches a high level between 25 mg and 50 mg per day, reaching 250 mg per day late in pregnancy. Progesterone levels of 14-15 mg are associated wit miscarriages.
13
Q
estrogen
A
mainly serves to cause enlargement of the uterus, breast and breast glandular tissue.
14
Q
human placental lactogen (hPL)
A
is similar to human pituitary growth hormone as it stimulates certain changes in the mom’s metabolic process. Detected 4 weeks after conception
15
Q
relaxin
A
remodels collagen, softens the cervix, and softens ligaments and cartilage in the skeletal system.
16
Q
melanin
A
linae nigra and chloasma
17
Q
Primary function of amniotic fluid
A
- acts as a cushion to protect the embryo against mechanical injury.
- Helps control the embryo’s temperature (relies on mom to release heat)
- Permit symmetric external growth and development of the embryo.
- Prevents adherence of the embryo-fetus to the amnion, thus aiding in musculoskeletal development.
- Allow the umbilical cord to be relatively free of compression.
- Act as an extension of fetal extracellular space.
- Fluid is slightly alkaline and contains several items including fine hairs called lanugo.
- Fluid at 10 weeks= 30 mL; 210 mL at 16 weeks, 28 weeks ranges 700-1000mL. At 39 weeks the amniotic fluid begins to decrease.
- Abnormal variations are Oligohydramnios (less than 400 mL) and Hydramnios (polyhydramnios) (over 2000 mL).
18
Q
4 week fetal development
A
fetal heart begins to beat.
19
Q
8 week fetal development
A
body organs are formed; embryo is most vulnerable to teratogenesis
20
Q
8-12 week fetal development
A
Fetal heart rate can be heard by ultrasound or doppler device.
21
Q
16 week fetal development
A
baby’s sex can be seen and fetus looks like a baby.
22
Q
20 week fetal development
A
fetal heart beat can be heart with fetoscope, mother feels baby move (quickening), baby has routine of sleeping, kicking, baby assumes favorite position in uterus, vernix caseola protects the skin, head hair, eyebrows, and eyelashes are present.
23
Q
24 weeks fetal development
A
fetus weighs 1 lb 10 oz, activity is increasing, fetal respiratory movements begin, and sucking movements begin.
24
Q
28 weeks fetal development
A
eyes open and close, baby can breathe if out of utero at this time. Surfactant is formed and baby is 2/3rd its inal weight.
25
32 weeks fetal development
baby has fingernails and toenails, subcutaneous fat is present, and fetus is less red and wrinkled
26
38 + weeks fetal development
Fetus fills the whole uterus and baby gets antibodies from mother.
27
Blood leaves the placenta and enters the fetus through?
umbilical vein
28
after circulating through the fetus, the blood returns through the placenta through the
2 umbilical arteries.
29
What allows the blood to bypass the fetal liver and lungs?
Ductus venosus, foramen ovale and the ductus arteriosus.
30
What are the 3 vessels of the umbilical cord called?
one umbilical vein and two umbilical arteries.
31
Which vessel of the umbilical cord carried oxygenated blood?
umbilical vein
32
Organs are formed primarily during
8 week embryo development.
33
Hazardous agents are called
teratogens
34
Vena cava compressed by fetus and uterus is call
supine hypotension
vena cava syndrome
aortic coddle syndrome
35
Subjective (presumptive)changes: symptoms that women experience and reports
```
ammenorrhea
nausea and vomiting
urinary frequency
breast tenderness
quickening
```
36
Objective (probable) changes: signs the examiner can see
```
goodell sign
chadwicks sign
hegar sign
mcdonald sign
uterine enlargement
enlargement of the abdomen
braxton hicks contractions
uterine souffle
chloasma
linea nigra
nipples/areolae
abdominal striae
fetal outline
ballottement
pregnancy test
```
37
possible Causes of amenoorhea
```
endocrine factors: early menopause; lactation; thyroid, pituitary, adrenal, ovarian dysfunction
metabolic factors: malnutrition, anemia, climatic changes, diabetes mellitus, degenerative disorders, long-distance running
Psychological factors: emotional shock, fear of pregnancy or sexually transmitted infection, intense desire pregnancy (pseudocyesis), stress
Obliteration of endometrial cavity by infection or curettage
systemic disease (acute or chronic), such as tuberculosis or malignancy
```
38
Causes of Nausea and vomiting
gastrointestinal disorders
acute infections such as encephalitis
emotional disorders such as pseudocyesis or anorexia nervosa
39
possible causes of urinary frequency
```
UTI
cystocele
pelvic tumors
urethral diverticula
emotional tension
```
40
possible Causes of Breast tenderness
premenstrual tension
Chronic cystic mastitis
pseudocyesis
hyperestrogenism
41
possible causes of quickening
increased peristalsis
flatus
abdominal muscle contractions
shifting of abdominal contents
42
Possible causes of change in pelvic organs
increased vascular congestion
43
Possible cause of goodell sign
estrogen-progestin oral contraceptives
44
possible cause of chadwick sign
vulvar, vaginal, cervical hyeremia
45
possible cause of hegar sign
excessively soft walls of nonpregnant uterus
46
possible cause of uterine enlargement
uterine tumors
47
possible causes for enlargement of abdomen
obesity, ascites, pelvic tumors
48
possible causes of braxton hicks contractions
hematometra, pedunculated, submucous, and soft myomas
49
complete blood count
Hemoglobin should be performed in women of African, Southeast Asian, & Mediterranean descent to evaluate for sickle cell disease & thalassemia's.
Hemoglobin or hematocrit is done to evaluate for iron deficiency anemia.
50
tuberculin test
typically we say to wait until after the first trimester
51
Quadruple screen
Blood test of mother's serum between 15-20 weeks. Indicates risk of fetal neural tube defect, multiple gestation or pregnancy that is further along than believed. Lower than normal indicates Down Syndrome or trisomy 18.
52
Gestational Diabetes
Is typically done between 24 and 28 weeks. If results above 140 (fasting), a 50g 1 hour glucose screen is recommended. If abnormal a 100 g 3 hour glucose screen is performed. If above 200 you may be started on a medication.
53
Group B Streptococcus (GBS)
Rectal and vaginal sabs are taken at 35-37 weeks.
54
newborn pulse
110-160 bpm
55
newborn respirations
30-60 respirations/min
56
newborn blood pressure
70-50/45-30 mmHg birth
| 90/50 mmHg at day 10
57
newborn temperature
97.5-99.4
58
newborn weight
5 lb 8 oz - 8 lb 13 oz
59
nb length
46-56 cm
60
head circumference (nb)
32-37 cm
61
chest circumference
30-35 cm
62
APGAR
Appearance (skin color): Pale or blue/pink body, blue extremities/ pink body and extremities
Pulse (heart rate): absent/ less than 100/ greater than 100
Grimace (reflex response) absent/ grimace; noticeable facial movement/ vigorous cry; cough; sneezes; pulls away when touched
Activity (muscle tone) flaccid/some flexion of extremities/active movement of extremities
Respiration absent/slow; irregular/good breathing w/crying
63
in the following situations, nb should be stabilized rather than remain with parents in the birth area for an extended period of time
- apgar less than 8 at 1 minute and less than 9 at 5 minutes or baby requires resuscitation measures
- respiration below 30 or above 60
- apical pulse below 120 or above 160
- skin temp below 97.8
- skin color pale blue or circumoral pallor
- baby less than 38 weeks or more than 42 weeks
- baby very small or very large for gestational age
- congenital anomalies involving open areas in the skin (meningomyelocele)
64
category 1 FHR
- normal range FHR 110-160
- Normal FHR variability in the moderate range
- absence of variability in the moderate range
- accelerations may be present or may be absent
- early decelerations may be present or may be absent; they do not represent a nonreassuring status
65
Category II FHR
- Baselines that include bradycardia with continued variability, or tachycardia
- Baseline changes in variability that include minimal variability, absent variability without decelerations or marked baseline variability
- lack of accelerations with fetal scalp stimulation
- episodic decelerations that include recurrent variable decelerations with minimal or moderate variability, prolonged decelerations lasting >2 min but < 10 min in duration or recurrent late decelerations that maintain moderate variability
- variable deceleration patterns that include overshoots, shoulders, or slow return to baseline status
66
Catergory III FHR
- Absent variability in baseline FHR with recurrent late decelerations, recurrent variable decelerations, and/or bradycardia.
67
cause of early decelerations
compression of baby's head on pelvis/soft tissue
| - normal, no intervention required as long as stays in 120-160 range
68
cause of late decelerations
uteroplacental insufficiency, nonreassuring requires intervention
69
cause of variable decelerations
cord compression, requires intervention
70
reactive Nonstress test
accelerations (at least 2) of 15 beats/min above the baseline, lasting 15 seconds or more in a 20 minute window.
71
Gestational Trophoblastic disease
aka molar pregnancy and hydatidiform mole;
rapid uterine growth
- is the proliferation and degeneration of trophoblastic villi in the placenta that becomes swollen, fluid filled and takes on the appearance of grape-like clusters. Embryo fails to develop and associated with choriocarcinoma which is a rapidly metastasizing malignancy.
- anemia from blood loss
bleeding is often dark brown like prune juice.
72
Bishop Score
```
cervical dilation
cervical effacement
cervical consistency
cervical position
station of presenting part
```
73
Goodell sign
softening of the cervix
74
chadwick sign
bluish purple, or deep-red discoloration of the mucous membranes of the cervix
75
hegar sign
softening of the isthmus of the uterus, the area between the cervix and the body of the uterus.
76
Mcdonald sign
is an ease in the flexing of the body of the uterus against the cervix.
77
braxton hicks contractions
can be palpated most commonly after the 28th week
78
uterine souffle
it is a soft blowing sound that occurs at the same rate as the maternal pulse and is caused by increased uterine blood flow and blood pulsating through the placenta (heard over the uterus when the the abdomen is ausculatated).
other possible causes: large uterine myomas, large ovarian tumors, or any condition with greatly increased uterine blood flow.
79
Chloasma
facial melasma
| other causes: melanoctye hormonal stimulation
80
Linea nigra
line on the abdomen
| other causes: melanocyte hormonal stimulation
81
nipples/areolae
darken nipples and areolae
| other causes: melanocyte hormonal stimulation
82
abdominal striae
stretch marks
| other causes: obesity, pelvic tumors
83
ballottement
is the passive fetal movement elicited when the examiner inserts two gloved fingers into the vagina and pushes against the cervix. This actions pushes the fetal body up, and as it falls back, the examiner feels a rebound.
other causes: uterine tumors/polys, ascites
84
positive pregnancy test
other causes: increased pituitary gonadotropins at menopause, choriocarcinoma, hydatifiform mole.
85
palpitation for fetal outline
uterine myomas
86
Mcdonald method
measurement of the fundal height
87
fundus just above the pubis
10-12 weeks
88
fundus midway between the pubis and the umbilicus
16 weeks
89
fundus at the umblicus
20 weeks, from 20 weeks , weeks corresponds to measurement.
90
What are the components of the Biophysical profile?
```
Nonstress test (FHR)
fetal breathing movements
gross body movements
fetal tone
qualitative amniotic fluid volume
```
91
amniocentesis
removal of amniotic fluid by insertion of a needle into the amniotic sac; amniotic fluid is used to assess fetal health or maturity.
92
chronic villus sampling
Procedure in which a specimen of the chorionic villi is obtained from the edge of the developing placenta at about 8 weeks gestation. The sample cam be used for chromosomal, enzyme and DNA tests.
93
What is the medication a gestational diabetic is typically put on to control blood sugar?
insulin (analog, short acting and intermediate acting)
94
ultrasound crown-rump measurement for estimated date of birth
8-10 weeks
95
Quadruple screen for neural tube defects (maternal serum alpha-fetoprotein, hcG, unconjugated estriol, inhibin A).
16-18 or 20 weeks
96
ultrasound confirms gestational age and diagnoses multiple pregnancy or congenital anomalies
18 weeks
97
fetal echocardiogram
20-22 weeks
98
begins ultrasound for assessment of fetus and fetal growth
24 weeks
99
Ultrasound for growth. Begin daily fetal movement counting. Start weekly nonstress test (NST). If evidence of of IUGR, preeclampsia, oligohydramnios, or poorly controlled blood glucose exists, testing may begin as early as 26 weeks and may be done more often.
28 weeks
100
ultrasound for growth
32 weeks
101
increase to twice weekly NST or weekly Biophysical profile. if the NST is nonreactive, a fetal biophysical profile or contraction stress test is performed. If the woman requires hospitalization, NSTs may be done daily
32 weeks
102
ultrasound for growth
36 weeks
103
amniocentesis for women with poor glycemic control to document fetal pulmonary maturity prior to elective birth. Omit amniocentesis if maternal or fetal condition suggests jeopardy to either
37-39 weeks
104
Birth without amniocentesis for women that have maintained good glycemic control and have excellent dating criteria
39-40 weeks
105
gynecoid
favorable for vaginal birth; inlet rounded with all inlet diameters adequate; midpelvis diameters adequate with parallel side walls; outlet adwqaute
106
anthropoid
favorable for vaginal birth; inlet oval in shape, with long anteroposterior diameter; midpelvis diameters adequate; outlet adequate
107
android
not favorable for vaginal birth; descent into pelvis is slow; fetal head enters pelvis in transverse or posterior position, with arrest of labor frequent.
108
platypelloid
not favorable for vaginal birth; fetal head engages in transverse position; difficult descent through midpelvis; frequent delay of progress at outlet of pelvis.
